The risk of total mortality and cardiovascular mortality associated with impaired glucose regulation in Tayside, Scotland, UK: a record-linkage study in 214 094 people
The risk of total mortality and cardiovascular mortality associated with impaired glucose regulation in Tayside, Scotland, UK: a record-linkage study in 214 094 people
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DOI：
10.1136/bmjdrc-2015-000102
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发表时间：
2015-01-01
影响因子：
4.1
通讯作者：
Leese, Graham P.
中科院分区：
文献类型：
--
作者：
Evans, Josie M. M.;Eades, Claire E.;Leese, Graham P.
目的：研究设计和方法：使用2003-2008年的记录相关数据，所有人群中血糖检测的实例定义了2个年龄为18岁以上患者的队列：根据WHO标准，IGR患者（无论是空腹血糖受损还是糖耐量受损（IGT）），以及血糖正常的患者。在死亡率或心血管死亡率的生存分析中，（删失30天试验期内发生的死亡），以得出HR使用考克斯回归，校正年龄、性别和剥夺的面积测量，计算IGR状态的95% CI。214094例患者进行了2372712次检测，其中非IGR队列196799例患者，IGR队列50080例患者。随访期间，2个队列分别有19147例（9.7%）和8397例（16.8%）患者死亡，死亡率分别为33.2/1000患者-年和70.7/1000患者-年。在多变量分析中，IGR的总体校正死亡风险为1.16（95%CI 1.13至1.20）。然而，对于年龄< 45岁的人群，这一比例为2.59（95% CI 2.17至3.10），而对于年龄大于85岁的人群，这一比例降至0.94（95% CI 0.85至1.00）。心血管死亡率的HR总体上较低，但遵循相同的模式，仅年龄< 64岁的患者风险增加具有统计学意义。IGT患者的死亡风险最高。结论：IGR与死亡风险增加相关，并随年龄增长而下降。因此，重要的是要优先考虑年轻人IGR的预防;但不太重要的是积极改变老年人的危险因素。
Objective: Mortality among adults of all ages diagnosed with impaired glucose regulation (IGR) in Tayside, Scotland, UK, was evaluated using routinely collected healthcare data sets.Research design and methods: Using recordlinked data in 2003-2008, all instances of blood glucose testing in the population defined 2 cohorts of patients aged 18+ years: those with IGR (whether impaired fasting glucose or impaired glucose tolerance (IGT)) according to the WHO criteria, and those who were normoglycemic. They were followed in survival analyses for mortality or cardiovascular mortality ( censoring deaths that occurred within a 30-day period of testing), to derive HRs (with 95% CI) for IGR status using Cox regression, adjusted for age, sex, and an area measure of deprivation.Results: There were 2 372 712 tests for 214 094 patients, with 196 799 patients in the non-IGR cohort and 50 080 in the IGR cohort. During follow-up, 19 147 (9.7%) and 8397 (16.8%) patients died in 2 cohorts, respectively, with mortality rates of 33.2/1000 patient-years and 70.7/1000 patient-years. In multivariable analyses, the overall adjusted risk of mortality for IGR was 1.16 (95% CI 1.13 to 1.20). However, it was 2.59 (95% CI 2.17 to 3.10) for people aged < 45 years, decreasing to 0.94 (95% CI 0.85 to 1.00) in those aged 85+ years. The HRs for cardiovascular mortality were lower overall, but they followed the same pattern, with statistically significant increased risks for patients aged < 64 years only. The mortality risk was highest among patients with IGT.Conclusions: IGR is associated with an increased mortality risk which declines with age. It is therefore important to prioritize young people with IGR for prevention; but less important to be aggressive about risk factor modification in older people.